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1.
J Prim Care Community Health ; 13: 21501319211066667, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34986693

RESUMO

OBJECTIVE: This study aims to evaluate the safety, utilization, ability to reduce length of hospitalization and overall outcomes of a COVID-19 virtual ward providing ongoing treatment at home. METHOD: A retrospective single-center study of patients discharged to the COVID-19 virtual "step down" ward between January 27th 2021 and March 2nd 2021. The referral process, length of hospitalization, length of stay on the virtual ward, readmissions, and ongoing treatment requirements including supplemental oxygen, antibiotics, and/or steroids were all noted. RESULTS: A total of 50 patients were referred to the virtual ward. 43 referrals were accepted, 39 of which were from the respiratory ward. Four patients were readmitted, all due to hypoxia. All readmissions occurred within 5 days of discharge. 72% (n = 31) were discharged home with an ongoing oxygen requirement. 14.3% of patients were discharged with antibiotics only, 9.5% with steroids only and 23.8% with both antibiotics and steroids. The mean length of hospital stay for patients discharged to the virtual ward was 10.3 ± 9.7 days and 11.9 ± 11.6 days for all covid positive patients during this time. On average, patients spent 13.7 ± 7.3 days on the virtual ward. The average number of days spent on oxygen on the virtual ward was 11.6 ± 6.0 days. CONCLUSION: The virtual ward model exemplifies the potential benefits of collaborative working between primary and secondary care services, relieving pressure on hospitals whilst providing ongoing treatments at home such as supplemental oxygen. It also facilitates an early supported discharge of clinically stable patients with an improving clinical trajectory by managing them in the community.


Assuntos
COVID-19 , Hospitais Gerais , Humanos , Tempo de Internação , Alta do Paciente , Estudos Retrospectivos , SARS-CoV-2 , Reino Unido
2.
Home Healthc Now ; 40(1): 27-39, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34994718

RESUMO

Despite an increasing demand for pediatric home care nursing, there is no comprehensive or universal standard of care for prescribing pediatric home care nursing hours based on a child's medical complexity. Adoption of a qualification tool (QT) to allocate home care nursing hours based on the medical complexity of a child may mitigate inequality in access to care and improve the patient and family experience. A QT, developed in Minnesota, recommends home care nursing hours based on the level of medical complexity and need for skilled nursing interventions. Four hypothetical case studies demonstrate the use of the QT to calculate recommended nursing hours. To validate the tool, a survey of discharge planners found a percentage difference in calculated hours of 4.1, 5.7, 11.2, and 24.9 in the four case studies. Discharge planners rated the usability of the QT as favorable with a score of 3.6 on a Likert scale of 5. The recommended nursing hours prescribed for families, based on the QT, was perceived as meeting the needs of the child by 56% and 42% of surveyed parents and home care nurses (HCNs), respectively. The need for additional nursing hours was expressed by 33% and 50% of parents and nurses, respectively. In general, HCNs' assessment of allocated nursing hours paralleled that of parents. Further refinement and adoption of a standardized QT to allocate home care nursing hours may improve access and outcomes for children requiring home care nursing.


Assuntos
Serviços de Assistência Domiciliar , Criança , Família , Humanos , Minnesota , Pais , Alta do Paciente , Inquéritos e Questionários
3.
BMJ Case Rep ; 15(1)2022 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-35027388

RESUMO

A 77-year-old woman presented with obscure gastrointestinal bleeding requiring multiple hospitalisations and blood transfusions. The patient underwent repeated investigations over four hospital admissions across a span of two months. These included upper and lower gastrointestinal endoscopy, video capsule endoscopy as well as CT enterography, without definitive localisation or treatment of the source of bleeding. Finally, a technetium-99m-labelled red blood cell scan demonstrated a 'blush' at the proximal transverse colon on delayed imaging. Targeted colonoscopic evaluation showed a subcentimetre angiodysplastic lesion in the corresponding spot at the proximal transverse colon with slow persistent oozing. Endoscopic clips were applied with successful haemostasis. The patient recovered well without further symptom recurrence 5 months postdischarge. We review the literature on colonic angiodysplasias and discuss the diagnostic challenges in obscure gastrointestinal bleeding.


Assuntos
Angiodisplasia , Endoscopia por Cápsula , Assistência ao Convalescente , Idoso , Angiodisplasia/complicações , Angiodisplasia/diagnóstico , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Alta do Paciente
4.
Am J Occup Ther ; 76(1)2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34997839

RESUMO

IMPORTANCE: Unplanned hospital readmissions can profoundly affect older adults' quality of life and the financial status of skilled nursing facilities (SNFs). Although many clinical practices focus on reforming these issues, occupational therapy's involvement remains unclear. OBJECTIVE: To explore clinical practices aimed at reducing hospital readmissions of older adults pursuing postacute care (PAC) at SNFs and describe how they align with occupational therapy's scope of practice. DATA SOURCES: We searched CINAHL, Scopus, PubMed, and OTseeker for articles published from January 2011 to February 2020. Study Selection and Data Collection: We conducted a scoping review of peer-reviewed articles with functional outcomes of clinical practices reducing unplanned hospital readmissions of patients older than age 65 yr pursuing PAC services in SNFs. Trained reviewers completed the title and abstract screens, full-text reviews, and data extraction. FINDINGS: Thirteen articles were included and focused on five areas: risk and medical disease management and follow-up, hospital-to-SNF transition, enhanced communication and care, function, and nutrition. Early coordination of care and early identification of patients' needs and risk of readmission were common features. All clinical practices aligned with occupational therapy domains and processes, but only 1 study specified occupational therapy as part of the research team. CONCLUSIONS AND RELEVANCE: Comprehensive, multipronged clinical practices encompassing care coordination and early identification and management of acute conditions are critical in reducing preventable readmissions among older adults pursuing PAC services in SNFs. Further research is needed to support occupational therapy's value in preventing hospital readmissions of older adults in this setting. What This Article Adds: This scoping review maps the presence of occupational therapy's domains and processes in the clinical practices that reduce hospital readmissions of older adults pursuing PAC services in SNFs. Findings provide occupational therapy practitioners with opportunities to assume roles beyond direct patient care, research, advocate, and publish more, thereby increasing their presence and adding value to occupational therapy interventions that reduce hospital readmissions.


Assuntos
Readmissão do Paciente , Instituições de Cuidados Especializados de Enfermagem , Idoso , Humanos , Alta do Paciente , Qualidade de Vida , Cuidados Semi-Intensivos
5.
Int Breastfeed J ; 17(1): 6, 2022 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-35012631

RESUMO

BACKGROUND: Mothers of preterm infants face many challenges in breastfeeding, especially regarding lactation. This study aimed to investigate the lactation status and challenges in breastfeeding faced by preterm infants' mothers. METHODS: We approached 124 mothers who gave birth to preterm infants between 26 May and 31 October 2018 in a tertiary hospital in China. Lactation status and challenges in breastfeeding on day 7 postpartum, at discharge of infants, 2 weeks post-discharge, and 3 months of corrected age were collected using questionnaires. The area under the receiver operating characteristic (ROC) curve for expressed milk volume on day 7 postpartum for predicting expressed milk volume ≥ 300 mL/d at discharge was calculated. Logistic regression analyses were performed to identify factors associated with delayed lactogenesis II onset and continuation of breastfeeding at 3 months of corrected age. RESULTS: Seventy mothers were enrolled, and 51.4% had delayed lactogenesis II. Multivariate logistic regression analysis revealed that older maternal age (aOR = 1.19; 95% CI: 1.01, 1.40) and first live birth (aOR = 4.81; 95% CI 1.43, 16.18) were significant independent predictors of delayed lactogenesis II. Mothers with delayed lactogenesis II had significantly lower expressed milk volume (day 7 postpartum: 160.0 mL vs. 300.0 mL, U = 328.50, p = 0.001; at discharge: 425.0 mL vs. 612.5 mL, U = 372.00, p = 0.005), with a lower proportion of exclusive breastfeeding in their infants (at discharge: 33.3% vs. 69.8%, χ2 = 12.39, df = 1, p < 0.001; 3 months of corrected age: 17.8% vs. 52.8%, χ2 = 11.03, df = 1, p = 0.001). The ROC showed that expressed milk volume > 190 mL/d on day 7 postpartum significantly predicted expressed milk volume ≥ 300 mL/d at discharge. Insufficient human milk was the main reason for breastfeeding discontinuation at 3 months of corrected age. Twins were less likely to continue breastfeeding at 3 months of corrected age (aOR = 0.27; 95% CI 0.09, 0.86). In singleton infants, mother's own milk ≥50% of total milk uptake at 2 weeks post-discharge (aOR = 32.66; 95% CI 3.00, 355.25) was an independent predictor of continuous breastfeeding at 3 months of corrected age. Feeding complications in infants, poor breastfeeding technique, and low milk output are the main challenges in breastfeeding. CONCLUSION: Interventions to improve early postpartum lactation and breastfeeding techniques may increase breastfeeding adoption in mothers of preterm infants.


Assuntos
Aleitamento Materno , Mães , Adolescente , Assistência ao Convalescente , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Lactação , Alta do Paciente , Gravidez , Estudos Prospectivos
6.
Eur Heart J Acute Cardiovasc Care ; 11(1): 20-31, 2022 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-35024801

RESUMO

AIMS: Bystander cardiopulmonary resuscitation and defibrillation can double survival to hospital discharge in out-of-hospital cardiac arrest. Mobile phone applications, such as GoodSAM, alerting nearby volunteer first-responders about out-of-hospital cardiac arrest could potentially improve bystander cardiopulmonary resuscitation and defibrillation, leading to better patient outcomes. The aim of this study was to determine GoodSAM's effect on survival to hospital discharge following out-of-hospital cardiac arrest. METHODS AND RESULTS: We collected data from the Out-of-Hospital Cardiac Arrest Outcomes Registry (University of Warwick, UK) submitted by the London Ambulance Service (1 April 2016 to 31 March 2017) and East Midlands Ambulance Service (1 January 2018 to 17 June 2018) and matched out-of-hospital cardiac arrests to GoodSAM alerts. We constructed logistic regression models to determine if there was an association between a GoodSAM first-responder accepting an alert and survival to hospital discharge, adjusting for location type, presenting rhythm, age, gender, ambulance service response time, cardiac arrest witnessed status, and bystander actions. Survival to hospital discharge was 9.6% (393/4196) in London and 7.2% (72/1001) in East Midlands. A GoodSAM first-responder accepted an alert for out-of-hospital cardiac arrest in 1.3% (53/4196) cases in London and 5.4% (51/1001) cases in East Midlands. When a responder accepted an alert, the adjusted odds ratio for survival to hospital discharge was 3.15 (95% CI: 1.19-8.36, P = 0.021) in London and 3.19 (95% CI: 1.17-8.73, P = 0.024) in East Midlands. CONCLUSION: Alert acceptance was associated with improved survival in both ambulance services. Alert acceptance rates were low, and challenges remain to maximize the potential benefit of GoodSAM.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Aplicativos Móveis , Parada Cardíaca Extra-Hospitalar , Hospitais , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Alta do Paciente , Voluntários
7.
Bull World Health Organ ; 100(1): 10-19, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35017753

RESUMO

Objective: To describe the implementation, coverage and performance of the national kangaroo mother care programme in Bangladesh. Methods: Kangaroo mother care services for clinically stable babies with birth weight under 2000 g were set up in government-run health-care facilities in rural and urban areas of Bangladesh. Each facility provided counselling on kangaroo mother care, ensured adequate nutrition, and followed up mothers and babies. We studied implementation of the programme from January 2016 to March 2020 using data from the national database. We tracked the number of eligible babies enrolled and their outcomes, mortality and post-discharge follow-up. Findings: The numbers of kangaroo mother care facilities increased from 16 in 2016 to 108 in 2020. Over the 4-year period 64 426 babies weighing under 2000 g were born in these facilities, 6410 of whom received kangaroo mother care. The quarterly percentage of eligible babies receiving kangaroo mother care increased from 4.7% (37/792) during the first quarter to 21.7% (917/4226) during the last five quarters of the programme. Deaths of babies receiving kangaroo mother care showed a downward trend over the study period. The overall mortality was 1.2% (77/6410), with large quarterly fluctuations in mortality. Post-discharge follow-up was low and only 15-20% of babies received four follow-up visits. Conclusion: Implementation of kangaroo mother care interventions is feasible in low-resource settings. Such care has the potential to reduce mortality among low-birth-weight and premature babies. Challenges include low coverage, expanding the programme to the community and strengthening the monitoring system.


Assuntos
Método Canguru , Assistência ao Convalescente , Bangladesh , Criança , Feminino , Humanos , Lactente , Mortalidade Infantil , Alta do Paciente
8.
BMC Health Serv Res ; 22(1): 59, 2022 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-35022053

RESUMO

BACKGROUND: Veterans increasingly utilize both the Veteran's Health Administration (VA) and non-VA hospitals (dual-users). Dual-users are at increased risk of fragmented care and adverse outcomes and often do not receive necessary follow-up care addressing social determinants of health (SDOH). We developed a Veteran-informed social worker-led Advanced Care Coordination (ACC) program to decrease fragmented care and provide longitudinal care coordination addressing SDOH for dual-users accessing non-VA emergency departments (EDs) in two communities. METHODS: ACC had four core components: 1. Notification from non-VA ED providers of Veterans' ED visit; 2. ACC social worker completed a comprehensive assessment with the Veteran to identify SDOH needs; 3. Clinical intervention addressing SDOH up to 90 days post-ED discharge; and 4. Warm hand-off to Veteran's VA primary care team. Data was documented in our program database. We performed propensity matching between a control group and ACC participants between 4/10/2018 - 4/1/2020 (N- = 161). A joint survival model using Markov Chain Monte Carlo technique was employed for 30-day outcomes. We performed Difference-In-Difference analyses on number of ED visits, admissions, and primary care physician (PCP) visits 120-day pre/post discharge. RESULTS: When compared to a matched control group ACC had significantly lower risk of 30-day ED visits (Hazard Ratio (HR) = 0.61, 95% Confidence Interval (CI) = (0.42, 0.92)) and a higher probability of PCP visits at 13-30 days post-ED visit (HR = 1.5, 95% CI = (1.01, 2.22)). Veterans enrolled in ACC were connected to VA PCP visits (50%), VA benefits (19%), home health care (10%), mental health and substance use treatment (7%), transportation (7%), financial assistance (5%), and homeless resources (2%). CONCLUSION: We developed and implemented a program addressing dual-users' SDOH needs post non-VA ED discharge. Social workers connected dual-users to needed follow-up care and resources which reduced fragmentation and adverse outcomes.


Assuntos
Veteranos , Assistência ao Convalescente , Hospitais de Veteranos , Humanos , Alta do Paciente , Determinantes Sociais da Saúde , Estados Unidos , United States Department of Veterans Affairs
9.
Pediatr Emerg Care ; 38(1): e387-e392, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34986592

RESUMO

OBJECTIVES: The pediatric emergency department (PED) is an especially high-risk setting for medication errors. Several factors contribute to this risk including the need to provide care to complex patients who are unknown to staff, the frequent use of verbal orders, and the necessity of weight-based dosing. This investigation sought to assess one potentially error-prone event, antibiotic prescriptions written for patients being discharged from the PED, and to characterize the occurrence of medication errors to identify opportunities for improvement. METHODS: This was a retrospective study of pediatric patients seen at a large academic medical center PED. All prescriptions written for an antibiotic for patients 18 years or younger that were discharged from the PED from 2015 to 2018 were evaluated for errors in directions, indication, dose, quantity, and refills. Because antibiotic dosing can vary based on indications, only disease states with guideline-specific dosing recommendations were evaluated for dosing errors. RESULTS: A total of 11,815 antibiotic prescriptions were analyzed for patients discharged from the PED, and 1986 (16.8%) errors were identified. Of all the prescriptions reviewed, 517 (4.4%) contained an incomplete prescription error. Discharge prescriptions written by off-service physicians were more likely to contain incomplete prescription errors (5.1%) when compared with emergency medicine physicians (3.9%; P = 0.022). A dosing error rate of 18.5% (1469 prescriptions) was identified for the 7930 disease state-specific prescriptions reviewed. Underdosing errors were significantly more common (51.6%) than overdosing errors (29.3%; P < 0.0001). Among the different agents, there was noted to be a significant difference in the antibiotics most commonly involved in dosing errors (P < 0.0001). Additionally, there was also a significant difference in the incidence of dosing errors between different disease states (P < 0.0001). No significant difference was found in the incidence of dosing errors across physician specialties (P = 0.872). CONCLUSIONS: We identified 1986 (16.8%) total errors in this analysis of antibiotic prescriptions written on discharge from the PED. Among the disease states evaluated, dosing errors were identified in 18.5% of prescriptions with the most common error being underdosing. Literature evaluating pediatric prescription errors, and specifically antibiotic discharge prescriptions, is quite limited. Further investigation is necessary in this area, and strategies should be developed leveraging technology, enhancing education, and using pharmacy personnel to help reduce antibiotic prescribing errors for patients discharged from the PED.


Assuntos
Antibacterianos , Alta do Paciente , Criança , Prescrições de Medicamentos , Serviço Hospitalar de Emergência , Humanos , Estudos Retrospectivos
10.
Reprod Health ; 19(1): 5, 2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-35012569

RESUMO

BACKGROUND: A Near Miss Mother (NMM) who survives life-threatening conditions, experiences intense physical, emotional, and psychological consequences following the maternal near-miss (MNM) events. The aim of this study was therefore to explore indepth understanding meaning of NMM everyday lived experiences on the social and cultural background of Iran. METHODS: This qualitative study utilized a hermeneutic phenomenology procedure. The study was conducted in hospitals affiliated with the Educational, Research and Treatment Centerwhich usually handle the NMMs. The sampling was purposeful with a maximum variation of eleven NMMs. Datawere collected using unstructured face-to-face interviews, and thetranscribed data were analyzed using Diekelmann, Allen, and Tanner's seven-stage thematic analysis approach. RESULTS: "Death-stricken survivor mother" was the central emerged theme, and three extracted sub-themes included: "Distorted psyche on a journey to death", "physical destruction due to an ominous event ", and the "vicissitudinous life after reviving ". These sub-themes, in turn, involved 12 sub-themes that emerged from 38 common meanings and 1200 codes. CONCLUSIONS: Findings demonstrate that the living conditions of NMMs are mixed in all aspects of the MNM event. They need a supportive program that includes additional follow-up visits, psychological support from the time of hospitalization until long-time after discharge, alleviation of social, sexual, and financial worries to return them to the normal life, as well as psychosocial rehabilitation to increase their life quality. Furthermore, post-discharge care in NMMs should be done actively and directly at their homes.


A maternal near miss (MNM) is a life-threatening condition experienced by a mother with organ failure due to severe maternal morbidity. Near miss mother (NMM) experiences adverse outcome such as physical, emotional, and psychological consequences after near miss event. Understanding the meaning of these mothers' lived experience and listening to their voices will help in reducing the burden of complications and will be effective in rehabilitating the disability created in their life. "Death-stricken survivor mother" was the central emerged theme resulting from the study of phenomenology. The main body of this theme reflects the severe physical, psychological burden and vicissitudes life. Server maternal morbidity due pregnancy and childbirth, have made NMM mother's life very different from those of normal mothers. The living conditions of these mothers are mixed in all aspects of the MNM event. Long-term physical and psychological damages they have endured, should be on the agenda of women's health policy makers to support them for years after discharge with integrated care.


Assuntos
Near Miss , Complicações na Gravidez , Assistência ao Convalescente , Feminino , Humanos , Mães , Alta do Paciente , Sobreviventes
12.
Int Emerg Nurs ; 60: 101125, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34953437

RESUMO

BACKGROUND: Unplanned return visits to the emergency department (ED) have been associated with adverse outcomes and may reflect the quality of care delivered. Several studies speculate the reasons for return and suggest clinician behaviour as potentially influencing a patient's decision to return to the ED. There is little research about this issue from the clinician's perspective, which is necessary to inform future practice improvement. METHODS: A descriptive cross sectional design was employed to ascertain perspectives on identification and management of return visits occurring within 48 hours of discharge. An electronic survey was distributed to all medical, nursing, and clerical staff at one ED. Descriptive statistics were used for quantitative data and content analysis was performed on textual data. Results were categorised as barriers or facilitators, then mapped to the Theoretical Domains Framework. RESULTS: A response rate of 59.7% (n=86/144) was achieved. Staff reported increased levels of concern for this patient group but not all staff were aware of the policy for managing return patients (40.7%). Five barriers and three facilitators were identified that mapped to eight influencers of behaviour including knowledge, memory and environmental factors. CONCLUSION: Overall, staff were aware of return patients but lacked familiarity with policy and processes to identify and commence relevant protocols. Further review of current practice as well as the patient perspective is required before any intervention to improve practice is developed.


Assuntos
Serviço Hospitalar de Emergência , Alta do Paciente , Estudos Transversais , Humanos , Inquéritos e Questionários
13.
J Intensive Care Med ; 37(1): 134-143, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33626957

RESUMO

BACKGROUND: There is conflicting evidence on the association between afterhours discharge from the intensive care unit (ICU) and hospital mortality. We examined the effects of afterhours discharge, including the potential effect of residual organ dysfunction, on hospital mortality in a large integrated health region. METHODS: We performed a multi-center retrospective cohort study of 10,463 adults discharged from 9 mixed medical/surgical ICUs in Alberta from June 2012 to December 2014. We applied a 2-stage modeling strategy to investigate the association between afterhours discharge (19:00h to 07:59h) and post-ICU hospital mortality. We applied mixed-effect multi-variable linear regression to assess the relationship between discharge organ dysfunction and afterhours discharge. We then applied mixed-effect multi-variable logistic regression to evaluate the direct, indirect and integrated associations of afterhours discharge on hospital mortality and hospitalization duration. RESULTS: Of 10,463 patients, 23.7% (n = 2,480) were discharged afterhours, of which 27.4% occurred on a holiday or weekend. This varied significantly by ICU size, type, and site. Patients discharged afterhours were more likely medical admissions, had greater multi-morbidity and illness acuity. A greater average SOFA score in the 72 hours prior to ICU discharge was not associated with afterhours discharge. However, a greater average SOFA score was associated with hospital mortality (adjusted-odds ratio [OR], 1.23; 95% CI, 1.18-1.28). Afterhours discharge was associated with higher hospital mortality (adjusted-OR, 1.19; 95% CI, 1.01-1.39), increased hospital stay (adjusted-risk ratio [RR], 1.10; 95% CI, 1.09-1.11) and increased post-ICU stay (adjusted-RR, 1.16; 95% CI, 1.14-1.17) when compared with workhours discharge. CONCLUSIONS: Afterhours discharge is common, occurring in 1 in 4 discharges, and is widely variable across ICUs. Patients discharged afterhours have greater risk of hospital mortality and prolonged hospitalization.


Assuntos
Unidades de Terapia Intensiva , Alta do Paciente , Estudos de Coortes , Mortalidade Hospitalar , Humanos , Tempo de Internação , Estudos Retrospectivos
14.
J Nurs Care Qual ; 37(1): 54-60, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33734187

RESUMO

BACKGROUND: In an inpatient setting, aspects of discharge planning are often left to the provider's memory, leading to errors, inefficiencies, and avoidable costs. METHODS: A multidisciplinary team of oncology practitioners used process improvement methodologies to redesign the discharge planning process. INTERVENTIONS: The primary intervention was an evidence-based discharge planning tool, called the discharge navigator, used from admission through discharge. RESULTS: Thirty-day unplanned readmission rates decreased by 29.0% from preimplementation (March 2017 through August 2017) to postimplementation (September 2017 through March 2020). The percentage of patients discharged before noon increased 76.2%. A comparable service not utilizing the intervention saw lesser or no improvement in these measures. CONCLUSION: The tool provided a systematic approach to discharge planning. Key design elements included a centralized location within the electronic health record and an electronic shortcut to populate the tool. Although developed for a specialized population, most elements are applicable to any hospitalized patient.


Assuntos
Alta do Paciente , Readmissão do Paciente , Humanos , Pacientes Internados
15.
Psychiatry Res ; 307: 114303, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34896844

RESUMO

During the first wave of the SARS-CoV-2 contagion in Italy, mental health care services continuity has been granted to the general population. Emergent and urgent conditions, however, are managed in collaboration with Emergency Departments (EDs). This collaboration may have suffered from the overload of the EDs due to the high number of SARS-CoV-2 positive patients. In this perspective, we analysed the possible impact of COVID-19 on the EDs accesses of psychiatric patients in two of the main hospitals of Milan, the "Luigi Sacco" Hospital and the "Fatebenefratelli" Hospital, comparing their admissions between the periods of March, April and May 2019 and 2020. We found a significant reduction in the number of evaluated patients in 2020 in both EDs. Emergency Medical Services (EMSs) brought a significant lower number of patients to the ED of Sacco Hospital during 2020, while this number increased for the ED of Fatebenefratelli Hospital, confirming the hypothesis that the overload of the Sacco Hospital ED significantly influenced the possibility to receive a psychiatric evaluation there. Moreover, we found a significant difference between diagnosis at discharge of the different samples.


Assuntos
COVID-19 , Serviço Hospitalar de Emergência , Hospitais , Humanos , Alta do Paciente , SARS-CoV-2
17.
Arch Cardiovasc Dis ; 115(1): 37-47, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34952827

RESUMO

BACKGROUND: Concomitant or cured coronavirus disease 2019 (COVID-19) in patients with myocardial infarction (MI) may lead to difficulties in acute care management and impair prognosis. AIMS: To describe and compare the characteristics, care management and 90-day post discharge outcomes of patients hospitalized for MI who did not have COVID-19 with those of patients with concomitant or previous hospital-diagnosed COVID-19. METHODS: This population-based French study included all patients hospitalized for MI in France (30 December 2019 to 04 October 2020) from the French National Health Data System. Outcomes were described for each COVID-19 group and compared using adjusted logistic regression analysis. RESULTS: Among 55,524 patients hospitalized for MI, 135 had previous hospital-diagnosed COVID-19 and 329 had concomitant COVID-19. Patients with previous hospital-diagnosed COVID-19 had more personal history of cardiovascular diseases than those without concomitant/previous confirmed COVID-19. In-hospital and 90-day post discharge mortality rates of patients with previous COVID-19 were 8.1% and 4.0%, respectively, compared with 3.5% and 3.0% in patients without concomitant/previous confirmed COVID-19 (odds ratio [OR]adjin-hospital 1.83, 95% confidence interval [CI] 0.97-3.46; ORadjpostdischarge 0.77, 95% CI 0.28-2.13). Patients with concomitant COVID-19 had more personal history of cardiovascular diseases, but also a poorer prognosis than their no concomitant/no previous confirmed COVID-19 counterparts; they presented excess cardiac complications during hospitalization (ORadj 1.62, 95% CI 1.29-2.04), in-hospital mortality (ORadj 3.31, 95% CI 2.32-4.72) and 90-day post discharge mortality (ORadj 2.09, 95% CI 1.24-3.51). CONCLUSIONS: In-hospital and 90-day post discharge mortality of patients hospitalized for MI who had previous hospital-diagnosed COVID-19 did not seem to differ from those hospitalized for MI alone. Conversely, concomitant COVID-19 and MI carried a poorer prognosis extending beyond the hospital stay. Special attention should be given to patients with simultaneous COVID-19 and MI, in terms of acute care and secondary prevention.


Assuntos
COVID-19 , Infarto do Miocárdio , Assistência ao Convalescente , Mortalidade Hospitalar , Hospitalização , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Alta do Paciente , SARS-CoV-2
18.
Pediatrics ; 149(1)2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34972220

RESUMO

In this Ethics Rounds we present a conflict regarding discharge planning for a febrile infant in the emergency department. The physician believes discharge would be unsafe and would constitute a discharge against medical advice. The child's mother believes her son has been through an already extensive and painful evaluation and would prefer to monitor her well-appearing son closely at home with a safety plan and a next-day outpatient visit. Commentators assess this case from the perspective of best interest, harm-benefit, conflict management, and nondiscriminatory care principles and prioritize a high-quality informed consent process. They characterize the formalization of discharge against medical advice as problematic. Pediatricians, a pediatric resident, ethicists, an attorney, and mediator provide a range of perspectives to inform ethically justifiable options and conflict resolution practices.


Assuntos
Serviço Hospitalar de Emergência/ética , Alta do Paciente , Recusa de Participação/ética , Recusa do Paciente ao Tratamento/ética , Tomada de Decisão Compartilhada , Febre de Causa Desconhecida , Humanos , Lactente , Masculino , Urinálise , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico
19.
Pediatrics ; 149(1)2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34972225

RESUMO

BACKGROUND: Transportation influences attendance at posthospitalization appointments (PHAs). In 2017, our pediatric hospital medicine group found that our patients missed 38% of their scheduled PHAs, with several being due to transportation insecurity. To address this, we implemented a quality improvement project to perform inpatient assessment of transportation insecurity and provide mitigation with the goal of improving attendance at PHAs. METHODS: The process measure was the percentage of patients with completed transportation insecurity screening, and the outcome measure was PHA attendance. An interprofessional team performed plan-do-study-act cycles. These included educating staff about the significance of transportation insecurity, its assessment, and documentation; embedding a list of local transportation resources in discharge instructions and coaching families on using these resources; notifying primary care providers of families with transportation insecurity; and auditing PHA attendance. RESULTS: Between July 2018 and December 2019, electronic health record documentation of transportation insecurity assessment among patients on the pediatric hospital medicine service and discharged from the hospital (n = 1731) increased from 1% to 94%, families identified with transportation insecurity increased from 1.2% to 5%, and attendance at PHAs improved for all patients (62%-81%) and for those with transportation insecurity (0%-57%). Our balance measure, proportion of discharges by 2 pm, remained steady at 53%. Plan-do-study-act cycles revealed that emphasizing PHA importance, educating staff about transportation insecurity, and helping families identify and learn to use transportation resources all contributed to improvement. CONCLUSIONS: Interventions implemented during the inpatient stay to assess for and mitigate transportation insecurity led to improvement in pediatric PHA attendance.


Assuntos
Assistência ao Convalescente/organização & administração , Assistência ao Convalescente/normas , Agendamento de Consultas , Alta do Paciente/normas , Melhoria de Qualidade , Transportes , Lista de Checagem , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/normas , Humanos , Maine
20.
Esc. Anna Nery Rev. Enferm ; 26: e20210232, 2022. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1350742

RESUMO

Resumo Objetivo identificar respostas comportamentais apresentadas por longevos no domicílio, após internação na Unidade de Terapia Intensiva e alta hospitalar. Método estudo qualitativo, realizado com pessoas de 80 anos ou mais. O cenário da coleta de dados foi a Unidade de Terapia Intensiva e o domicílio de longevos que estiveram internados na unidade, por meio de entrevista aberta. Para análise dos dados, utilizou-se o método de análise de conteúdo de Bardin, pautada na teoria de Adaptação de Callista Roy. Todos os cuidados éticos foram respeitados. Resultados emergiram-se duas categorias: Alterações do padrão de resposta às necessidades fisiológicas e perda de autonomia e Alterações psicossociais e comprometimento na realização de atividades cotidianas de lazer e laborais. Conclusão e implicações para a prática as respostas comportamentais foram relacionadas aos modos fisiológicos e psicossociais, que culminaram em dependência e perda de autonomia para realização das atividades básicas de vida. Perceberam-se dificuldades vivenciadas no retorno ao domicílio, que provocaram alterações significativas na realização de atividades cotidianas, evidenciando a necessidade de se iniciar o preparo para o retorno domiciliar, pela equipe multiprofissional, ainda durante a hospitalização. Espera-se que estratégias visando melhorias dos resultados de cuidados críticos sejam implementadas nessa população.


RESUMEN Objetivo identificar respuestas comportamentales presentadas por longevos en el domicilio después de internación en la Unidad de Cuidados Intensivos y alta hospitalaria. Método estudio cualitativo, realizado con personas de 80 años o más. El escenario de la recolección de datos fue la Unidad de Cuidados Intensivos y el domicilio de longevos que estuvieron internados en la unidad, por medio de entrevista abierta. Para el análisis de los datos se utilizó el método de análisis de contenido de Bardin, pautado en la teoría de Adaptación de Callista Roy. Todos los cuidados éticos fueron respetados. Resultados surgieron dos categorías: Alteraciones del patrón de respuesta a las necesidades fisiológicas y pérdida de autonomía y Alteraciones psicosociales y compromiso en la realización de actividades cotidianas de ocio y laborales. Conclusión e implicaciones para la práctica las respuestas comportamentales fueron relacionadas a los modos fisiológicos y psicosociales, que culminaron en dependencia y pérdida de autonomía en la realización de las actividades básicas de la vida. Se percibieron dificultades vividas en el retorno al domicilio, que provocaron alteraciones significativas en la realización de actividades cotidianas, revelando la necesidad de iniciar la preparación para el retorno domiciliar por el equipo multiprofesional aún durante la hospitalización. Se espera que estrategias que busquen mejoras de los resultados de cuidados críticos sean implementadas en esa población.


Abstract Objective to identify the behavioral responses presented by elderly people at home after hospitalization at the intensive care unit and hospital discharge. Method a qualitative study was conducted with people aged 80 years or older. The data collection setting was the intensive care unit and the homes of the elderly people hospitalized in the unit using open interviews. Data analysis consisted of Bardin's method of content analysis based on the Callista Roy adaptation model. All ethical aspects were respected. Results two categories emerged: changes in the pattern of response to physiological needs and loss of autonomy and psychosocial changes and impairment in performing daily leisure and work activities. Conclusion and implications for practice behavioral responses were related to physiological and psychosocial factors, culminating in dependence and loss of autonomy to perform basic life activities. Difficulties experienced in returning home were also noticed, which caused significant changes in daily activities, thereby evidencing the need for multidisciplinary teams to begin preparing for the return home during hospitalization. Strategies seeking to improve critical care outcomes are highly suggested to be implemented in this population.


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Alta do Paciente , Saúde do Idoso , Resultados de Cuidados Críticos , Autonomia Pessoal , Pesquisa Qualitativa , Estado Funcional , Unidades de Terapia Intensiva , Tempo de Internação
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